Osteopathic manipulation and its applicability in the emergency department: A narrative review.

BACKGROUND: Osteopathic manipulative treatment (OMT), also known as osteopathic manipulative medicine (OMM), is a set of manual techniques, developed by Dr. Andrew Taylor Still, founder of osteopathic medicine, initially limited to osteopathic medicine, for the treatment of painful conditions. This toolset is now used by allopathic physicians, international osteopaths, physical therapists, chiropractors, and other healthcare workers for the treatment of musculoskeletal pain. OMT can be used in the emergency department (ED) for the treatment of musculoskeletal complaints as an adjunct to pharmacologic agents (e.g., NSAIDs), or an alternative to opioids. OBJECTIVE: This narrative review provides emergency clinicians with an understanding of OMT, including a broad overview of the basis, development, and common subtypes of OMT; data on OMT efficacy and on the use of conditions commonly encountered in the ED setting; and information on how to implement the use of OMT in emergency medicine and urgent care settings. DISCUSSION: OMT can be used for a wide variety of acute and chronic pain conditions, particularly back pain, headaches, neck pain, and extremity pain (assuming that life-threatening conditions have been excluded). There are small studies and case series demonstrating both efficacy and subjective improvement with OMT, including in the ED. However, limitations to the current body of literature include: small numbers of patients, challenges with blinding and standardization, limited adverse event reporting, and most research has been outside of the ED setting. There is great opportunity for future studies and application of OMT in the ED. There are an increasing number of emergency clinicians incorporating OMT in their practice and despite the perception of OMT requiring extended periods of time to perform, current data suggests OMT does not prolong ED visits or cost to patients. OMT is a procedure with billing codes, and courses and training in OMT are available for both osteopathic and allopathic physicians. CONCLUSION: OMT is being used and has great potential in the management of acute and chronic musculoskeletal pain in the ED in addition to, or instead of pharmacologic agents, in particular as an opioid-sparing option.

Thoracic outlet syndrome in whiplash injury.

Thirty-five cases of thoracic outlet syndrome complicating whiplash or cervical strain injury were studied. Thirty cases had confirmation by the demonstration of slowed ulnar nerve conduction velocity (UNCV) through the thoracic outlet. Two distinct groups of patients were found. An acute group, seen an average of 3 1/2 months post injury, had severe neck pain with often mild or incidental thoracic outlet syndrome. A chronic group, with symptoms persisting more than 2 years after cervical injury, often had thoracic outlet symptoms as the predominant complaint. This study suggests that the arm aches and parethesias seen in association with both acute and chronic cervical strain injury are most often secondary to thoracic outlet syndrome.

Posterior fossa subdural haematoma associated with anticoagulant therapy.

This is a report of spontaneous posterioir fossa subdural haematoma associated with anticoagulation therapy. The possibility of posterior fossa lesions related to spontaneous haemorrhage is suggested by the combination of severe headache and increasing disturbance of consciousness associated with signs of brain-stem decompensation. A thorough neurological evaluation including appropriate contrast studies will help rule out a supratentorial lesion. This is a neurological emergency which can be successfully treated by early detection and prompt surgical decompression. This is the second reported case of spontaneous subdural haematoma of the posterior fossa occurring during anticoagulant therapy.